Are You Ready for Next Year’s E/M Coding Changes?
Prepare Now for 2021 Changes With New AAFP Resources
(Editor's Note: Legislation that Congress approved on Monday, Dec. 21, delays implementation of the primary care add-on code, G2211, which was scheduled to take effect on Jan. 1. All other anticipated payment, coding and documentation changes for 2021 are expected to go into effect as planned. AAFP staff will be updating resources throughout the Academy website to reflect this change.)
October 20, 2020, 2:48 pm News Staff -- Evaluation and management services are at the heart of what practicing family physicians do every day. That means, of course, that correctly documenting and coding for these services is essential to a practice’s bottom line.
That’s why the AAFP is pulling out all the stops to ensure you’re fully prepared to tackle new office visit E/M documentation and coding guidelines established by the AMA that go into effect on Jan. 1.
Here’s a quick recap of next year’s updates:
- five levels of office visit E/M services will be retained for established patients (CPT codes 99211-99215);
- for new patients, the number of levels will drop to four (CPT codes 99202-99205);
- time and medical decision-making methodologies will be revised for all office visit E/M codes, and history-taking and exams will only be required when medically appropriate;
- physicians will be able to choose the E/M visit level based either on total time or solely on medical decision-making; and
- CMS is finalizing a new primary care add-on code intended to reflect visit complexity. (See Editor's Note above.)
The changes, which aim to lessen physicians’ administrative burden and allow them to spend more time on direct patient care, come in the wake of extensive advocacy by the AAFP and other medical groups.
But as AAFP News noted in coverage published in September, there’s no reason to wait until January to learn about the new guidelines. You can start right now by using the diverse collection of resources the Academy is offering to help you find out what you need to know today.
Story Highlights
The newest of these is the first installment in the Family Medicine Practice Hacks video series, which AAFP Manager of Practice and Payment Erin Solis describes as being designed to “share tips and tricks to help you more easily manage your practice.”
In this first video, Solis highlights some of the key resources on the Academy’s E/M webpage, including checklists outlining the steps that solo and independent practice physicians, as well as employed physicians, should be taking now to be ready to hit the ground running on Jan. 1.
Among tasks that solo, small and independent practices need to complete before the new guidelines take effect, Solis notes in the video, is talking with their EHR vendor to understand the specifics of how that vendor plans to update the system, what the timeline is for doing so and whether the practice should expect any downtime.
Solis also recommends that practices reach out to the payers they contract with to learn about their plans for implementing the new guidance, ask whether the changes will impact auditing protocols and processes, and verify that they will be increasing values for E/M services.
Practices also will need to work with their billing staff to ensure the charges in their billing system are updated. “This is crucial,” Solis says in the video. “If your fee schedule is increased, but you haven’t increased the charges in your system, payers will only pay what you charge them.” Failing to take this step means you’re leaving money on the table.
For employed physicians, the picture looks quite a bit different, given that most employers will handle the tasks noted above. Still, it’s important for employed physicians to learn about and feel comfortable with the changes, so it’s wise to take advantage of whatever training opportunities the employer offers.
“If your employer isn’t offering training, the AAFP’s Practice Training Outline may be helpful,” Solis notes.
Finally, Solis points to an upcoming module that will walk you through the new guidelines and provide a series of vignettes that let you practice applying them in specific clinical scenarios.
And don’t forget that you can now pre-order the AAFP’s E/M reference cards to get a jump on familiarizing yourself ― and your staff ― with the upcoming changes. Available in sets of five desk reference cards plus five pocket cards ― all laminated for durability ― this tool puts a wide range of information at your fingertips. Card orders will start shipping by Jan. 15.
One more thing: Be sure to check out the September/October issue of FPM, which features the first of three articles on E/M coding the journal will publish in the coming months. Look for the second installment in the November/December journal, and the final article is scheduled to run in the January/February issue.